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General NPI Number Information
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NPI Number | 1528230711
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Entity Type | Organization
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Legal Business Name | ERIE OPTICAL
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 8900 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6345
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Country | US
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Telephone | 440-255-7727
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Fax | 440-255-4288
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Provider Business Mailing Address
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Address Line | 8900 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6345
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Country | US
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Telephone | 440-255-7727
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Fax | 440-255-4288
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CONNIE BUCHANAN
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Credential |
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Telephone | 440-255-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3382
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License Number State | OH
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